Walk ambassador interest form 2013

The Walk MS ambassador will assist the Upper Midwest Chapter in raising awareness and increasing participation in his or her community's Walk MS event. The ambassador will volunteer 15-20 hours in the months leading up to the event by sharing his/her story, doing in media interviews, participating in MS Awareness Week and reaching out in the community to engage participation. Additionally, the ambassador will be recognized at his or her Walk MS event. Before nominating someone for this opportunity, we recommend asking them whether they'd like to take on this important role.

*1.

Question - Required -
What is the name of the person you are nominating? (enter your name if you are nominating yourself)

*2.

Question - Required -
Which event are you applying for?

*3.

Question - Required -
What is the nominee's connection to MS?

4.

Question - Not Required -
If you are nominating someone other than yourself, please provide the nominee's contact information.

5.

Question - Not Required -
What is your relationship to the nominee (if you are nominating someone other than yourself)?

*6.

Question - Required -
What makes the nominee an ideal ambassador?

7.

Question - Not Required -
Anything else you'd like to add?

8.

Please complete the following:

If you have previously registered, please
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to prepopulate your information.

*

Name:

First Required

Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required

State/Province Required

ZIP/Postal Code Required

Required

Phone Number:

Yes, I would like to receive important e-mail updates from the National MS Society.

Yes, I would like to receive important postal mail updates - including event announcements - from the National MS Society.